System and method for RF wake-up of implantable medical device

ABSTRACT

A telemetry system is presented for enabling radio-frequency (RF) communications between an implantable medical device and an external device in a manner which reduces the power requirements of the implantable device by duty cycling its RF circuitry. A wakeup scheme for the implantable device is provided in which the external device transmits a data segment containing a repeating sequence of special wakeup characters in order to establish a communications session with the implantable device. The wakeup scheme may be designed to operate in the context of a handshaking protocol for collision avoidance.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims the benefit of U.S. Provisional Application No.60/560,171, filed on Apr. 7, 2004, under 35 U.S.C. § 119(e), which ishereby incorporated by reference.

FIELD OF THE INVENTION

This invention pertains to implantable medical devices such as cardiacpacemakers and implantable cardioverter/defibrillators. In particular,the invention relates to a system and method for implementing telemetryin such devices.

BACKGROUND

Implantable medical devices, including cardiac rhythm management devicessuch as pacemakers and implantable cardioverter/defibrillators,typically have the capability to communicate data with a device calledan external programmer via a radio-frequency telemetry link. One use ofsuch an external programmer is to program the operating parameters of animplanted medical device. For example, the pacing mode and otheroperating characteristics of a pacemaker are typically modified afterimplantation in this manner. Modern implantable devices also include thecapability for bidirectional communication so that information can betransmitted to the programmer from the implanted device. Among the datathat may typically be telemetered from an implantable device are variousoperating parameters and physiological data, the latter either collectedin real-time or stored from previous monitoring operations.

Telemetry systems for implantable medical devices utilizeradio-frequency (RF) energy to enable bidirectional communicationbetween the implantable device and an external programmer. An exemplarytelemetry system for an external programmer and a cardiac pacemaker isdescribed in U.S. Pat. No. 4,562,841, issued to Brockway et al. andassigned to Cardiac Pacemakers, Inc., the disclosure of which isincorporated herein by reference. A radio-frequency carrier is modulatedwith digital information, typically by amplitude shift keying where thepresence or absence of pulses in the signal constitute binary symbols orbits. The external programmer transmits and receives the radio signalwith an antenna incorporated into a wand that can be positioned inproximity to the implanted device. The implantable device also generatesand receives radio signals by means of an antenna, typically formed by awire coil wrapped around the periphery of the inside of the devicecasing. Most conventional radio-frequency telemetry systems used forimplantable medical devices such as cardiac pacemakers utilize inductivecoupling between the antennas of the implantable device and an externalprogrammer in order to transmit and receive RF signals. Because theinduction field produced by a transmitting antenna falls off rapidlywith distance, such systems require close proximity between theimplantable device and a wand antenna of the external programmer inorder to work properly, usually on the order of a few inches. Thisrequirement is an inconvenience for a clinician and limits thesituations in which telemetry can take place.

Wireless radio-frequency communication over greater distances requiresthe use of far-field telemetry. Communication using far-field radiationcan take place over much greater distances, which makes it moreconvenient to use an external programmer. Also, the increasedcommunication range makes possible other applications of the telemetrysystem such as remote monitoring of patients and communication withother types of external devices such as network access points. In orderfor a substantial portion of the energy delivered to an antenna to beemitted as far-field radiation, the wavelength of the driving signalshould not be very much larger than the length of the antenna. Far-fieldradio-frequency communications with an antenna of a size suitable foruse in an implantable device therefore requires a carrier in thefrequency range of between a few hundred MHz to a few GHz. Activetransmitters and receivers for this frequency range require special RFcomponents (typically including SiGe or GaAs semiconductor devices) thatconsume a significant amount of power (typically tens of milliwatts).Implantable medical devices, however, are powered by a battery containedwithin the housing of the device that can only supply a limited amountof continuous power before it fails. When the battery fails in animplantable device, it must be replaced which necessitates are-implantation procedure. Power conservation is thus an importantdesign objective in wireless telemetry systems for implantable medicaldevices.

SUMMARY

The present invention relates to a telemetry system for enablingradio-frequency (RF) communications between an implantable medicaldevice and an external device in a manner which reduces the powerrequirements of the implantable device. In accordance with theinvention, the external device is programmed to transmit a data segmentcontaining a repeating sequence of special wakeup characters in order toestablish a communications session with the implantable device. Theimplantable device is programmed to power up its transmitter andreceiver for a specified time window at periodic intervals defined bythe wakeup timer and wait for receipt of one of the special wakeupcharacters transmitted by the external device. The implantable devicemaintains its transmitter and receiver in a powered-up state uponreceipt of a special character and for as long as consecutive specialwakeup characters continue to be received, to transmit an acknowledgesignal to the external device upon receipt of at least one characterother than a special wakeup character, and then to wait a specifiedperiod of time for a response from the external device. The externaldevice and the implantable device then attempt to establish acommunications session when a response to the acknowledge signal isreceived by the implantable device.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of a telemetry system for an implantabledevice and an external device.

FIG. 2 illustrates a handshaking protocol for collision avoidance.

FIG. 3 illustrates a wakeup scheme in accordance with the invention.

DETAILED DESCRIPTION

The present invention is a system and method for providing far-field RFtelemetry between an implantable medical device and an external devicein which power consumption by the implantable device is lessened bymanaging the duty cycle of the RF transmitting and receiving components.Long-range RF telemetry circuitry (i.e., the transmitter and receiver)typically requires power on the order of tens of milliwatts in order tooperate. Implantable cardiac devices in use today, on the other hand,are usually designed to operate with average power in the microwattrange. This means that the RF telemetry circuitry must be duty cycleddown in order to meet the power budget of such devices. Previousexamples of duty cycling for implantable devices are described in U.S.Pat. No. 5,342,408 and U.S. patent application Ser. No. 10/025,223,entitled “A TELEMETRY DUTY CYCLE MANAGEMENT SYSTEM FOR AN IMPLANTABLEMEDIACL DEVICE”, presently assigned to Cardiac Pacemakers, Inc., andhereby incorporated by reference.

The RF telemetry circuitry of an implantable device can either bepowered up or down, referred to as awake and sleep states, respectively.Duty cycling of the implantable device's RF telemetry circuitry can beimplemented by a wakeup timer which defines periodic wakeup intervals atwhich the implantable device powers up its RF circuitry and listens fora transmission from an external device for a specified period of time,referred to as a wakeup window. Upon acknowledging the transmission fromthe external device, a communications session can be established by ahandshaking protocol, and data can then be transferred between thedevices. In order to minimize power consumption, it is desirable for theRF circuitry of the implantable device to be powered up for as short atime as possible at each wakeup interval while still being able toreliably recognize session requests from the external device. If theimplantable device recognizes a session request from the external deviceduring its wakeup window, it remains awake long enough to establish acommunications session with the external device; otherwise, theimplantable device returns to a sleep state until the next wakeupinterval occurs.

In accordance with the present invention, the external device isprogrammed to transmit a data frame containing a repeating sequence ofspecial wakeup characters when it is desired to establish acommunications session with the implantable device. The implantabledevice is programmed to power up its transmitter and receiver for aspecified wakeup window at periodic intervals defined by its wakeuptimer and wait for receipt of one of the special wakeup characterstransmitted by the external device. The implantable device maintains itstransmitter and receiver in a powered-up state upon receipt of a specialcharacter and for as long as consecutive special wakeup characterscontinue to be received, and transmits an acknowledge signal to theexternal device upon receipt of at least one character other than aspecial wakeup character. After transmitting the acknowledge signal, theimplantable device then waits a specified period of time for a responsefrom the external device. When a response to the acknowledge signal isreceived by the implantable device, the external device and theimplantable device are programmed to establish a communications sessionby a handshaking protocol. During a communications session, the RFtransmitter and receiver of the implantable device may then either bemaintained in the powered-up state for the duration of thecommunications session or powered down at prescribed intervals accordingto a defined protocol.

As described in detail below, the wakeup scheme may be designed to workin the context of a medium access control (MAC) protocol by whichnetwork participants contend for access to the wireless medium. Also, inone embodiment, the implantable device and the external devicecommunicate by a transmission code which provides a DC balanced datastream such as 8b/10b. Such bit balanced data streams are advantageousin RF communications. In order for the special wakeup character to beinvariant, the special wakeup character may be selected as a bitbalanced sequence which is not changed by the transmission code.

In another particular embodiment, the external device is a remotemonitor (RM) which operates to periodically collect data from theimplantable device. The remote monitor may thus include a wakeup timerand be programmed to transmit a plurality of special wakeup charactersto the implantable device in an attempt to establish a communicationssession at periodic intervals as defined by its wakeup timer. After theimplantable device is awoken by the special wakeup characters, acommunications session is established in which the implantable devicetransmits whatever data it has to the RM. If the implantable device hasno data to transmit, however, the communications session is terminatedalmost immediately after being established. Such empty communicationssessions still impose an energy cost upon the implantable device,however, due to the time it takes for the implantable device to wake up,establish a communications session with the RM, indicate that there isnothing to download, and then terminate the session. The total dutycycle of the RF circuitry in the implantable device is thus a functionof both its own wakeup interval and the intervals at which the RMattempts to wake up the implantable device. In order to lessen powerconsumption by the implantable device, therefore, it is desirable forthe intervals at which the RM attempts to wake up the implantable deviceto be such that the number of empty communications sessions isminimized. The remote monitor may thus be further programmed to adjustthe periodic intervals at which it transmits a plurality of specialwakeup characters to the implantable device in accordance with whenprevious successful communications sessions have been established suchthat data was collected. In one particular embodiment, the remotemonitor is programmed to establish a communications session and collectdata from the implantable device on a daily basis and further programmedto adjust the periodic intervals at which it attempts to wake up theimplantable device in accordance with the time of day at which pastsuccessful communications sessions were established. In order to be ableto respond to an episode, the remote monitor may also be programmed totransmit a plurality of special wakeup characters to the implantabledevice for establishing a communications session when a user command isreceived via a user interface.

1. Exemplary Hardware Components

FIG. 1 shows the primary telemetry components of an external device 200and an implantable medical device 100. In this functional block diagram,the components are shown as being identical in each device. In thisexemplary embodiment, the external device and the implantable device aremicroprocessor-based devices each having a controller 102 a or 102 bthat includes a microprocessor and memory for data and program storagethat supervises overall device operation as well as telemetry. Codeexecuted by the controller also implements the duty cycle managementschemes to be described below. The implantable device 100 may be acardiac rhythm management device such as a pacemaker or implantablecardioverter/defibrillator, while the external device 200 may be anexternal programmer or a data-gathering device such as remote monitor. Auser interface 300 (e.g., a keyboard and monitor) enables a user such asa clinician to direct the operation of the external device.

A long-range RF receiver 120 a or 120 b and a long-range RF transmitter110 a or 110 b are interfaced to the microprocessor 102 a or 102 b inthe implantable device and the external device, respectively. Also ineach device, the transmitter and receiver are coupled to an antenna 101a or 101 b through a transmit/receive switch 130 a or 130 b. Thetransmit/receive switches 130 a and 130 b are controlled by themicroprocessor and either passes radio-frequency signals from thetransmitter to the antenna or from the antenna to the receiver. Toeffect communications between the devices, a radio-frequency carriersignal modulated with digital data is transmitted wirelessly from oneantenna to the other. A demodulator for extracting digital data from thecarrier signal is incorporated into each receiver, and a modulator formodulating the carrier signal with digital data is incorporated intoeach transmitter. The interface to the controller for the RF transmitterand receiver in each device enables data transfer. The implantabledevice also incorporates a means by which the controller can power up orpower down the RF receiver and/or transmitter in order to manage dutycycles in the manner described below. A wakeup timer 180 for definingthe RF duty cycle is also shown for the implantable device, and thistimer can either be implemented in code executed by the controller orcan be discrete components. FIG. 1 also shows an inductively coupledtransmitter/receiver 140 a or 140 b and antenna 150 a or 150 b for theimplantable and external devices by which communication may take placewithout concern for power consumption when the two devices are in closephysical proximity to one another.

2. Description of Specific Embodiments

A wireless telemetry system for implantable medical devices is generallya multiple access network in which a number of network participantsshare the available bandwidth of the wireless medium. A medium accesscontrol (MAC) protocol may be defined which allows each networkparticipant to acquire exclusive access to the medium beforetransmitting data to an intended recipient. A collision is said to occurwhen two or more participants attempt to transmit at the same time. Incertain networks, collisions may be detected by the sender listening tothe medium when a transmission is initiated to determine if othernetwork activity is present. If a collision is detected, the senderceases transmitting and waits for a random or defined period beforetrying again. Most wireless transceivers operate in a half-duplex mode,however, and cannot simultaneously transmit and listen for ongoingnetwork activity. MAC protocols for wireless networks thereforetypically use out-of-band signaling or a handshaking protocol tominimize the probability of a collision occurring. In an example of thelatter type of protocol, a four-way RTS-CTS-DS-ACK exchange asillustrated by FIG. 2 is used to avoid collisions. A network participantwho desires to send a message to a particular recipient first transmitsa request-to-send (RTS) frame and waits a defined period of time for aclear-to-send (CTS) frame from the intended recipient. All networkparticipants who hear either of the RTS or CTS frames defer theirtransmissions. Upon receiving the CTS response, the sender can assumethat the medium has been exclusively acquired and can then begintransmission of a data segment (DS) to the recipient. If the data isreceived without errors, the recipient responds with an acknowledge(ACK) frame which frees the medium for access by another participant.The present invention, in various embodiments, may work in the contextof any of the medium access control protocols discussed above.

a. Exemplary Wakeup Scheme

A particular embodiment of the invention will now be described withreference to an external programmer or remote monitor (PRM/RM) and animplantable device (referred to as a pulse generator or PG). In thisembodiment, the wakeup process works within the framework of ahandshaking collision avoidance scheme as described above. In such ascheme, a network participant may transmit a so-called universalbroadcast to all other participants in the network by transmitting anRTS-CTS-DS-ACK sequence. The PRM/RM transmits the RTS and CTS frames tocause other participants to defer their transmissions, transmits a datasegment DS, and then transmits an ACK frame to release the medium. Thewakeup process is illustrated by FIG. 3 and is similar to a universalbroadcast with the exception that the PG provides the ACK frame insteadof the PRM/RM. The PRM/RM sends out the messages RTS, CTS, and DS usingthe universal access code. The length of the DS message is set to alarge number (e.g., 256 bytes), and the entire data portion of themessage area is set to a repeating sequence of a special 10-bitcharacter reserved solely for use as a wakeup indicator. (As describedbelow, the wakeup indicator may be a special 8b10b character.) The PGwakes up periodically (e.g., every 20-30 seconds) and listens for a veryshort interval to receive the wakeup special character. This shortwakeup interval needs to be on the order of slightly longer than twentybits after the PG's RF receiver has stabilized so that at least oneentire 10-bit special character can be received. It is important to notethat any normal preamble that is designed to get the PG receiver to itssteady state of operation will not be present during the wakeup. Anadditional time is therefore required, on the order of an additional 10bits above the standard 20 bits for a total of 30 bits. This means thatthe minimum wakeup time in this embodiment is 50+bits (10+20+20), whichis 440 microseconds at a modulation rate of 113.7 Kbps. The projectionsbelow are based on a margin above this of 500 us allowing for a 6-bitmargin. If one wakeup special character is received, then the PG willstay awake long enough to receive several more wakeup specialcharacters. If several wakeup special characters are received, the PGstays awake until it no longer receives special characters. After twoconsecutive non-special characters (e.g., these could be the CRC valuesof the DS frame), the PG responds with an ACK frame and will now stayawake for an extended period of time. The PRM having successfullyreceived this ACK message will then proceed to perform a discoveryprocess which will contend for message traffic within the protocolframework in order to establish a communications session with the PG.

In the wakeup scheme just described, a problem may arise if two PG's arein range of the PRM/RM when the wakeup sequence is transmitted. If bothPG's wake up and respond to the wakeup sequence with an ACK frame, acollision will occur. In a further modification of the scheme, thePRM/RM may therefore be programmed to monitor the RF signal strengthafter transmission of the wakeup sequence during the expected ACKresponse time and proceed with the discovery process if there is foundto be some RF activity.

An advantage of the wakeup scheme described above is that the PRM/RM isable to quickly establish a communications session with the PG ondemand. The PG will be woken up within 20 seconds if the PG wakes upevery 20 seconds and wakes up when a special character is beingtransmitted. (The probability that the PG will be awoken within thattime increases with the length of the sequence of repeating specialcharacters transmitted by the PRM/RM.) At the same time, the PG issubjected to a very low duty cycle which lessens the power requirementsof operating a far-field RF telemetry system to acceptable levels. Forexample, an exemplary implantable cardiac rhythm management device mayoperate at an average current draw on the order of 22 microamps and isdesigned to last 6 years before a battery replacement is needed. Thismeans that each 305 nanoamps of current draw costs the device one monthin longevity. When the RF circuitry is powered up, its current draw ison the order of 4 milliamps. If the device wakes up every 20 seconds andremains powered up for 500 microseconds, the duty cycle is 1/40,000. Theaverage current due to wake ups (but not, of course, including thecurrent necessary for actually performing telemetry) is then (4 mA) (1/40,000)=100 nanoamps, resulting in a longevity cost to the device ofjust over a week.

b. Choice of Special Wakeup Character

In an embodiment where a DC balanced coding scheme such as 8b/10b isemployed, it is desired to know a priori that the wakeup specialcharacter is always going to have one value independent of the runningdisparity (RD) of the 8b/10b encoding. The first step in achieving thisgoal is to choose a wakeup preamble from the set of valid specialcharacters that is bit balanced. There are 7 such codes that haveexactly 5 ones and 5 zeros. Codes that are bit balanced do not changethe running disparity after transmission so that successive transmissionwould be identical values avoiding the inversion that occurs on non-bitbalanced codes. The second step is to determine what the initial runningdisparity is when the data portion of the DS message is sent. Since thismessage is predetermined, it is a simple matter to determine the runningdisparity. The RD has an initial negative value (RD−) and starts withthe first byte of the access code. The RD is then computed after each ofthe 8b/10b conversions. The RD at the start of the data portion is thenthe RD after the two universal access code bytes, the command byte, andthe length byte. The proposal for wakeup special character and universalaccess codes is to choose two of the 7 bit-balanced valid specialcharacters. The values are chosen as:

Code Special code name RD− RD+ Universal K28.0 0011110100 1100001011Access Code 1: Universal K28.4 0011110010 1100001101 Access Code 2:Wakeup Special Code: K29.7 1011101000 1011100111The choice of the RD− K28.0 and K28.4 codes are used as the universalaccess code. After transmission, the RD remains negative. The commandbyte and length byte are next to be transmitted. The command and lengthbytes depend on the value of the DS command code (3) and the length.Using a length of 256 bytes (0x100) gives a command byte of 0x31 and alength byte of 0x00 (The least significant two bits of the command arethe most significant bits of the length). The 0x31 command byte thenbecomes the 8b/10b code of D17.1 that is also bit balanced so the RDremains negative. The 0x00 length byte is the 8b10b code of D0.0 whichconverts to 1001110100, again this code is bit balanced so the RDremains negative. Now the wakeup special code K29.7 can be transmittedcontaining the RD− code of 101110 1000 repeatedly since the RD does notchange. The CRC can take on its normal value and does not need to beconsidered here since it does not affect the RD of the data portion.Note that the alignment pattern is the 8b10b code K28.5 (001111 1010)since it is the comma character.

Although the invention has been described in conjunction with theforegoing specific embodiments, many alternatives, variations, andmodifications will be apparent to those of ordinary skill in the art.Such alternatives, variations, and modifications are intended to fallwithin the scope of the following appended claims.

1. A telemetry system for enabling radio-frequency (RF) communicationsbetween an implantable medical device and an external device,comprising: an antenna, an RF transmitter, an RF receiver, and acontroller incorporated into each of the implantable and externaldevices; a wakeup timer incorporated into the implantable device whereinthe RF transmitter and receiver are interfaced to the controller in theimplantable device to enable the RF transmitter and receiver to bepowered up or down; wherein the external device is programmed totransmit a data segment containing a repeating sequence of specialwakeup characters in order to establish a communications session withthe implantable device; wherein the implantable device is programmed topower up its transmitter and receiver for a specified time window atperiodic intervals defined by the wakeup timer and wait for receipt ofone of the special wakeup characters transmitted by the external device;wherein the implantable device is programmed to maintain its transmitterand receiver in a powered-up state upon receipt of a special characterand for as long as consecutive special wakeup characters continue to bereceived, to transmit an acknowledge signal to the external device uponreceipt of at least one character other than a special wakeup character,and then to wait a specified period of time for a response from theexternal device; wherein the external device and the implantable deviceare programmed such that the external device transmits the data segmentcontaining the repeating sequence of special wakeup characters in thecontext of a handshaking protocol for collision avoidance in which theexternal device transmits an RTS and a CTS frame before the data segmentand in which the implantable device transmits an ACK frame in response;and, wherein the external device and the implantable device areprogrammed to establish a communications session when a response to theacknowledge signal is received by the implantable device.
 2. The systemof claim 1 wherein the RF transmitter and receiver of the implantabledevice are maintained in the powered-up state for the duration of thecommunications session.
 3. The system of claim 1 wherein the implantabledevice and the external device communicate by a transmission code whichprovides a DC balanced data stream.
 4. The system of claim 3 wherein thetransmission code is 8b/10b.
 5. The system of claim 3 wherein the wakeupspecial character is bit balanced and not changed by the transmissioncode.
 6. The system of claim 1 further comprising a wakeup timerincorporated into the external device and wherein the external device isprogrammed to transmit a plurality of special wakeup characters to theimplantable device in an attempt to establish a communications sessionat periodic intervals defined by its wakeup timer.
 7. The system ofclaim 6 wherein the external device is programmed to adjust the periodicintervals at which it transmits a plurality of special wakeup charactersto the implantable device after a successful communications session isestablished and data collected.
 8. The system of claim 6 wherein theexternal device is programmed to establish a communications session andcollect data from the implantable device on a daily basis.
 9. The systemof claim 8 wherein the external device is programmed to adjust theperiodic intervals at which it transmits a plurality of special wakeupcharacters to the implantable device in accordance with the time of dayat which past successful communications sessions were established. 10.The system of claim 6 wherein the external device is further programmedto transmit a plurality of special wakeup characters to the implantabledevice in an attempt to establish a communications session when a usercommand is received via a user interface.
 11. A method by which anexternal device communicates with an implantable medical device via awireless telemetry system, comprising: transmitting a data segmentcontaining a repeating sequence of special wakeup characters from theexternal device in order to establish a communications session with theimplantable device, wherein the implantable device powers up itstransmitter and receiver for a specified time window at periodicintervals and waits for receipt of one of the special wakeup characterstransmitted by the external device; wherein the implantable devicemaintains its transmitter and receiver in a powered-up state uponreceipt of a special character and for as long as consecutive specialwakeup characters continue to be received, transmits an acknowledgesignal to the external device upon receipt of at least one characterother than a special wakeup character, and then waits a specified periodof time for a response from the external device; wherein the externaldevice transmits the data segment containing the repeating sequence ofspecial wakeup characters in the context of a handshaking protocol forcollision avoidance in which the external device transmits an RTS and aCTS frame before the data segment and in which the implantable devicetransmits an ACK frame in response; and, establishing a communicationssession when a response to the acknowledge signal is received by theimplantable device.
 12. The method of claim 11 wherein the implantabledevice and the external device communicate by a transmission code whichprovides a DC balanced data stream.
 13. The method of claim 12 whereinthe transmission code is 8b/10b.
 14. The method of claim 13 wherein thewakeup special character is bit balanced and not changed by thetransmission code.
 15. The method of claim 11 further comprisingtransmitting a plurality of special wakeup characters to the implantabledevice in an attempt to establish a communications session at periodicintervals.
 16. The method of claim 15 further comprising adjusting theperiodic intervals at which the external device transmits a plurality ofspecial wakeup characters to the implantable device after a successfulcommunications session is established and data collected.
 17. The methodof claim 15 further comprising establishing a communications session andcollecting data from the implantable device on a daily basis.
 18. Themethod of claim 17 further comprising adjusting the periodic intervalsat which the external device transmits a plurality of special wakeupcharacters to the implantable device in accordance with the time of dayat which past successful communications sessions were established.